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射频消融联合心耳切除术治疗儿童心耳部位房性心动过速疗效探讨

Radiofrequency catheter ablation combined with appendectomy to cure pediatric atrial tachycardia originating from atrial appendages

摘要:

目的 探讨Carto三维电解剖标测系统指导下射频消融及心耳切除术对小儿起源于心耳房性心动过速(房速)的疗效以及起源于心耳房速的心电图特征.方法 因房速接受Carto电解剖标测射频消融患儿17例中证实为起源于心耳部位的房速5例,年龄3.2~12.8(8.1±4.6)岁,分析本5例患儿临床资料、心电图特点.应用Carto电解剖标测对相应心耳行冷盐水灌注射频导管消融,射频消融术后复发病例行外科心耳切除并观察其疗效.结果 全部接受三维电解剖标测射频消融房速患儿17例中,5例(29%)起源于心耳部位,其中3例起源于右心耳,2例起源于左心耳.Carto激动图提示电生理机制均为局灶性自律性增高.5例患儿即刻消融成功率100%,随访2~15个月,3例(60%)复发,分别于消融术后1周、1、2.5个月接受心耳切除术,夹闭心耳即刻转复为窦性心律,术后随访5~14个月,房速无复发.3例右心耳房速患儿心动过速时体表心电图P波特点:①Ⅰ、aVL导联为正向P波;②Ⅱ、Ⅲ、aVF导联P波直立;③V1导联P波为负向且为双峰.2例左心耳房速患儿心动过速时体表心电图P波特点:①Ⅰ、aVL导联为负向P波;②Ⅱ、Ⅲ、aVF导联P波直立;③V1导联P波直立(1例),或以直立为主的正负双向(1例).结论 ①在儿童局灶性房速中,起源于心耳部位者有独特的心电图特点;②Carto电解剖标测指导冷盐水消融成功率高,但术后易复发;③心耳切除术对起源于心耳房速的疗效可靠,术前需经Carto电解剖准确标测明确房速起源于心耳.

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abstracts:

Objective To investigate the effects of radiofrequency catheter ablation (RFCA) under guidance of three dimensional electroanatomic mapping system (Carto) combined with appendectomy to cure atrial tachycardia(AT) originating from atrial appendages in children.And to evaluate the electrocardiographic characteristics.Methods Of the 17 children with AT receiving RFCA under Carto system in our electrophysiology laboratory(EPL),5 were diagnosed as AT originating from atrial appendages,age 3.2 ~ 12.8 (8.1 ±4.6)years.Clinical data and electrocardiographic characteristics of these 5 children were retrospectively analyzed.Ablations were performed by cold saline infused catheter at appendages targeting loci of AT origin under guidance of Carto system.For those recurred after RFCA,appendectomies were performed.Results Of the 17 children with AT receiving RFCA under Carto system,5 (29%) originated from atrial appendages.Three were from right atrial appendage (RAA) and 2 were from left atrial appendage(LAA).Three dimensional mapping portraits revealed increased focal automaticity.Immediate success rate for RFCA was 100%.Three recurred (60%) during follow-up period (2 ~ 15months).Appendectomies were performed in them individually at 1 week,1 month and 2.5 months after RFCA.During operations,heart rhythm immediately reversed to sinus while appendages were clenched.No recurrence was detected during 5 ~ 14 months follow-up.Characteristics of P wave configuration for AT from RAA were:①positive P wave in Ⅰ and aVL leads;②positive P wave in Ⅱ,Ⅲand aVF leads ;③negative and double-peak P wave in V1 lead.Characteristics of P wave configuration for AT from LAA were:①negative P wave in Ⅰ and aVL leads;② positive P wave in Ⅱ,Ⅲ and aVF leads;③positive P wave in V1 lead (1 case)or bidirectional P wave with positive tendency (1 case).Conclusions ① The electrocardiographic characteristics of AT originating from atrial appendages in children are peculiar; ② RFCA under Carto mapping system by cooled tip cather is safe and effective for AT originating from atrial appendages in children while recurrence rate is high; ③ Appendectomy for AT originating from atrial appendage is reliable,while the accurate location of AT origin should be determined by Carto mapping system preoperatively.

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